Privacy Practice Notice

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THE INFORMATION: PLEASE TAKE THE TIME TO REVIEW CAREFULLY.

This Notice will describe to you how your Health information will be used and/or disclosed by ABLE Home Health, LLC/ABLE Home Services. It also describes your rights and our requirements concerning your protected health information. This notice covers the Home Health care services provided and the health care providers on our staff.

For further information concerning the providers or sites covered by this notice, contact the ABLE Home Health Office and ask to speak to our Administrator at (815) 399-2600.

How we will use or disclose Your health information: For treatment, payment or operations: ABLE Home Health, LLC/ ABLE Home Services health care providers may use or disclose your health information in order to provide you with treatment, to obtain payment for the treatment provided, or for health care operations, which are activities related to providing your health care: Example: health information may be used or disclosed to provide, coordinate, refer or manage your health care.

ABLE Home Health LLC may use or disclose your health information for payment purposes such as to to bill Medicare, Medicaid or Insurance for health care services that were provided you.

ABLE Home Health LLC may use or disclose your health information for health care operation purposes, such as conducting training programs for students or provider licensing or credentialing activities.

In addition ABLE staff will be contacting you to schedule appointments and to inform you of other services that may interest you.

Friends and family: We may disclose information to family, relatives and others whom you have identified as involved in your care, unless you request us not to. If you are unable to exclude family or friends during an emergency, information may be disclosed without your opportunity to object.

Additional use or disclosures made for compliance with the law or public health purposes: There can be many different situations in which we may use or disclose health information. Example: public health activities, required health oversight activities, law enforcement authorized use and disclosure, judicial or administrative proceedings, coroners or funeral home directors.

Additional disclosures will only be made with written authorization from you: For all other use or disclosure of your health information not previously written in this document, we will obtain a written authorization signed by you. At any time you can revoke this authorization in writing. Certain exceptions do apply such as information having already being disclosed that relied on the original authorization.

Your rights With respect to your own health information: Under the law, you have the right to ask to restrict certain uses or disclosures of your health information: concerning treatment, payment or health care operations and disclosure to family or friends. Although we are not obligated to agree, if we do accept your requested restriction, we will comply with your request except as needed to provide you emergency treatment.

-You have the right to ask that we communicate with you in a confidential manner. Example: request to communicate via a certain telephone number or to send information to a specific address. IF ADDITIONAL COST IS INCURRED ASSOCIATED WITH THIS REQUEST IT WILL BE NECESSARY TO CHARGE YOU FOR THE COST.

–You have the right to request a copy of your medical record, billing invoices, and any other health information. A fee will be assessed for supplying the requested information. A REASONABLE FEE WILL BE ASSESSED.

-You have the right to ask to amend your medical information, if you believe the record to be inaccurate or incomplete.

-You have the right to request a listing of all types of disclosures made of your health information. This accounting excludes items disclosed for routine purposes made for payment, treatment or operations.

All requests must be received in writing and be addressed to: ABLE Home Health, Administrator, 1946 Daimler Rd., Rockford, IL 61112

Our obligations to you as our patient: The law requires us to maintain the privacy of your protected health information and to provide you with this Notice which explains our privacy practices.

Any changes to the Notice of Privacy Practices will be posted on our website at www.ablehome.com

Contact our Administrator for any concerns or complaints: ABLE Home Health, LLC/ABLE Home Services are committed to following all Privacy Practices. If at any time you have a concern that your privacy rights have been violated please contact us so that we can address any concerns. Please call 815-399-2600 and ask for Richard Burkinshaw, ABLE Home Health Administrator. Or if you prefer to make an inquiry in writing please contact ABLE Home Health, 1946 Daimler Rd. Rockford, IL 61112. Attention: Administrator

If you feel that your concern or complaint was not satisfactorily taken care of you can file a complaint with: